Background: Improving child health is one of the major policy agendas for most of the governments, especially in the developing countries. These governments have been implementing various strategies such as improving healthcare financing, improving access to health, increasing educational level, and income level of the household to improve child health. Despite all these efforts, under-five and infant mortality rates remain high in many developing nations. Some previous studies examined how economic development or household&rsquo;s economic condition contributes to child survival in developing countries. In Ghana, the question as to what extent does economic circumstances of households reduces infant and child mortality still remain largely unanswered. Thus, the purpose of this study is to investigate the extent to which wealth affects the survival of under-five children, using data from the Demographic and Health Survey (DHS) of Ghana.

Methods: In this study, we use four waves of data from Demographic and Health Surveys (DHS) of Ghana from 1993 to 2008. The DHS is a detailed data set that provides comprehensive information on households and their demographic characteristics in Ghana. Data was obtained by distributing questionnaires to women (from 6000 households) of reproductive age between 15 and 49&nbsp;years, which asked, among other things, their birth history information. The Weibull hazard model with gamma frailty was used to estimate wealth effect, as well as the trend of wealth effect on child&rsquo;s survival probability.

Results: We find that household wealth status has a significant effect on the child survival in Ghana. A child is more likely to survive when he/she is from a household with high wealth status. Among other factors, birth spacing and parental education were found to be highly significant to increase a child&rsquo;s survival probability.

Conclusions: Our findings offer plausible mechanisms for the association of household wealth and child survival. We therefore suggest that the Government of Ghana strengthens and sustains improved livelihood programs, which reduce poverty. They should also take further initiatives that will increase adult education and improve health knowledge. To the best of our knowledge, this is the first study in Ghana that combines four cross sectional data sets from DHS to study a policy-relevant question. We extend Standard Weibull hazard model into Weibull hazard model with gamma frailty, which gives us a more accurate estimation. Finally, the findings of this study are of interest not only because they provide insights into the determinants of child health in Ghana and other developing countries, but they also suggest policies beyond the scope of health.

Fig1: Rural-urban distribution of mortality among children below age 5 from 1993 to 2008

Mentions:
The number of deaths in our sample as well as under-five mortality rates3 are illustrated in Fig. 1. The mortality rate is measured as number of deaths per 1000 live births. Figure 1 shows the trend in the number of deaths separately for urban and rural areas. The figure indicates that under-five mortality is higher in the rural areas compared to the urban areas, but it also shows that under-five mortality in the rural areas is reducing over time while that of urban areas is increasing over the same period.4 This may be related to effect of urbanization and the urban poor. Studies have found that in the past decade, urbanization has increased. Although this has helped to reduce absolute poverty in the aggregate, the increase in urbanization did little for urban poverty, and children are the most affected when poor households decide to live in slums in the urban centers mainly due to poor income accessibility. Thus, poor parents are not able to afford good nutrition and better healthcare for their children [40, 46, 49].Fig. 1

Fig1: Rural-urban distribution of mortality among children below age 5 from 1993 to 2008

Mentions:
The number of deaths in our sample as well as under-five mortality rates3 are illustrated in Fig. 1. The mortality rate is measured as number of deaths per 1000 live births. Figure 1 shows the trend in the number of deaths separately for urban and rural areas. The figure indicates that under-five mortality is higher in the rural areas compared to the urban areas, but it also shows that under-five mortality in the rural areas is reducing over time while that of urban areas is increasing over the same period.4 This may be related to effect of urbanization and the urban poor. Studies have found that in the past decade, urbanization has increased. Although this has helped to reduce absolute poverty in the aggregate, the increase in urbanization did little for urban poverty, and children are the most affected when poor households decide to live in slums in the urban centers mainly due to poor income accessibility. Thus, poor parents are not able to afford good nutrition and better healthcare for their children [40, 46, 49].Fig. 1

Background: Improving child health is one of the major policy agendas for most of the governments, especially in the developing countries. These governments have been implementing various strategies such as improving healthcare financing, improving access to health, increasing educational level, and income level of the household to improve child health. Despite all these efforts, under-five and infant mortality rates remain high in many developing nations. Some previous studies examined how economic development or household&rsquo;s economic condition contributes to child survival in developing countries. In Ghana, the question as to what extent does economic circumstances of households reduces infant and child mortality still remain largely unanswered. Thus, the purpose of this study is to investigate the extent to which wealth affects the survival of under-five children, using data from the Demographic and Health Survey (DHS) of Ghana.

Methods: In this study, we use four waves of data from Demographic and Health Surveys (DHS) of Ghana from 1993 to 2008. The DHS is a detailed data set that provides comprehensive information on households and their demographic characteristics in Ghana. Data was obtained by distributing questionnaires to women (from 6000 households) of reproductive age between 15 and 49&nbsp;years, which asked, among other things, their birth history information. The Weibull hazard model with gamma frailty was used to estimate wealth effect, as well as the trend of wealth effect on child&rsquo;s survival probability.

Results: We find that household wealth status has a significant effect on the child survival in Ghana. A child is more likely to survive when he/she is from a household with high wealth status. Among other factors, birth spacing and parental education were found to be highly significant to increase a child&rsquo;s survival probability.

Conclusions: Our findings offer plausible mechanisms for the association of household wealth and child survival. We therefore suggest that the Government of Ghana strengthens and sustains improved livelihood programs, which reduce poverty. They should also take further initiatives that will increase adult education and improve health knowledge. To the best of our knowledge, this is the first study in Ghana that combines four cross sectional data sets from DHS to study a policy-relevant question. We extend Standard Weibull hazard model into Weibull hazard model with gamma frailty, which gives us a more accurate estimation. Finally, the findings of this study are of interest not only because they provide insights into the determinants of child health in Ghana and other developing countries, but they also suggest policies beyond the scope of health.